The first vaccines against the SARS-CoV-2 virus appeared one year after the WHO declared COVID-19 as a pandemic, with data from United Kingdom and United States of America (USA) reporting a reduction in hospitalization about 67% e 94%, with one or two doses of an approved vaccine. In February 2021, the first cases of thrombocytopenia and thrombosis at uncommon sites (cerebral venous sinus and splanchnic venous thrombosis) induced by the vaccines were described. The incidence is still unknown, but early studies in the USA suggest an incidence of 1 in 533 333/vaccinated individuals, and this is probably underestimated. Although uncommon, it is a serious adverse effect with a high mortality rate, estimated at 20%. This case report highlights the need for a high level of suspicion, which may change the prognosis of some of these patients.

Introduction: Cerebral venous thrombosis (CVT) is a rare disease that affects mainly young people. The importance of recanalizationis controversial but it is related to residual symptoms/ signs. This study aims to calculate the incidence of CVT, to evaluatethe importance of recanalization and to define its predictive factors.Material and Methods: This is a retrospective observational study involving patients with CVT diagnosed between 2004 to 2014 in Braga Hospital. Functional assessment was based on the modified Rankin scale. Recanalization was defined as thepresence of venous flow in all vessels, including residual. A descriptive statistical analysis was conducted and used test t Student(t), Mann-Whitney U(U), chi-square(χ2) or Fisher’s exact test a binary logistic regression was used for predictive model. It wasrecognized statistical significance p < 0.05.Results: The incidence of CVT was estimated at 1.82 cases per 100 000 person-years. The recanalization was associated with the functional evaluation at 6 (Fisher’s exact test, p < 0.001, φc =0.511) and 12 months (Fisher’s exact test, p = 0.001, φc =0.480), inability to six (Fisher’s exact test, p = 0.024,φ = 0.305) and 12 months (Fisher’s exact test, p = 0.023,φ = 0.305), and the residual symptoms/signals at 3 months (χ2(1) = 23.46, p < 0.001,φ = 0.605). The obtained regression model included the following predictive variables age, arterial hypertension, dyslipidemia, altered state of consciousness and new residual symptoms/signs. This was statistically significant (χ2(5) = 37.43, p < 0.001), with a sensitivity of 90.0% and specificity of 70.8%. New residual symptoms/signs is the best predictor of no recanalization (OR = 33.33).Discussion and Conclusion: The recanalization has an important role in prognosis; it was possible to predict its occurrence basedon five variables.

INTRODUCTION: Phlegmasia cerulea (PC) is a severe form of deep vein thrombosis. In the setting of massive venous thrombosis and severe ischemia, catheter-directed thrombolysis (CDT) or trombectomy is mandatory. We report three cases of women with PC managed with venous thrombectomy after failure of CDT. CASE REPORTS: 1: 20 years-old, with recent intake of oral contraceptive, referred with acute onset of limb swelling, pain and a cold left lower extremity associated with foot pallor, paresthesia and numbness. Doppler ultrasound revealed occlusive thrombosis of the entire deep venous system and the great saphenous vein (GSV). Anticoagulation (AC) and CDT were started. However due to increasing levels of transaminases, creatine kinase and myoglobin, CTD was stopped and venous thrombectomy was proposed. A retrievable inferior vena cava flter (IVC) was implanted and venous surgical trombectomy. The completion venography showed a Cockett compression that was treated with stenting of the left iliac vein. Thrombophilia tests were positive for anticardiolipin antibodies an hyperhomocysteinemia. At 3-years follow-up, the patient is asymptomatic and under AC. The 3-year Doppler showed normal patency for the iliac stent and a mild femoropopliteal vein insuffency. 2: 19 year-old, taking oral contraceptives, with acute onset of PCD with acute thrombus in the left iliac, femoral, popliteal veins. CDT was started at admittance but stopped after two days because of very low values of serum fbrinogen and persistence of occlusive thrombus in the iliac vein. A retrievable IVC flter was placed and the thrombus removed with surgical thrombectomy. Phlebography showed no signifcant residual thrombus and no signs of compression were present. At 1 month follow-up, the patient presented without leg edema or venous claudication symptoms. Thrombophilia testing is awaited. 3: 54 year-old who presented with low back pain, worsening left leg pain and swelling with a cyanosed and colder foot. At doppler ultrasound there were monophasic arterial fow in the left leg. After exclusion of arterial embolism, the frst therapeutic approach was CDT, but it was also stopped due to very low fbrinogen levels and an ineffective thrombus lysis in venography controls. After implantation of a retrievable IVC, surgical thrombectomy via femoral vein was performed, with successful thrombus removal. Venography showed Cockett syndrome and a stent was implanted. At 6 months the patient remained without major symptoms, and Doppler confrmed stent patency with non residual obstruction or venous insuffciency. CONCLUSION: Awareness and timely diagnosis of phlegmasia cerulea is necessary to ensure prompt intervention to prevent loss of limb. When CDT is not effective, surgical thrombectomy remains successfully alternative. Iliac venous stenting complement is also crucial to treat associated Cockett syndrome. Endovascular thrombectomy devices may be a reasonable alternative to surgical thrombectomy

We report the case of a neonate who presented with a left abdominal flank mass and hemodynamic instability signs, with the final diagnosis of left renal vein thrombosis complicated with inferior vena cava thrombosis and perirenal hematoma. We illustrate the importance of an early imaging approach with ultrasound and Doppler evaluation to finally diagnose perinatal renal vein thrombosis and its complications. Teaching point: An early imaging approach with ultrasound and Doppler evaluation is fundamental to finally diagnose perinatal renal vein thrombosis and its complications.

An innovative technique for pancreas transplantation is described. The main aspect consists of the horizontal positioning of the pancreas, which allows a better venous outflow, thus preventing thrombosis and graft loss. The program of pancreas transplantation in this national reference center for pancreatic and liver surgery was started in 2007; the initial results were considered poor, resulting in the loss of half of the grafts due to venous thrombosis. After analyzing the possible causes, this technique was proposed and successfully implemented, reducing the postoperative complications, particularly the problem of venous thrombosis. A detailed description of the new surgical technique is provided. The main clinical and demographic characteristics of the 56 patients who underwent the surgery are analyzed. The incidence of venous thrombosis was 5.3% (3 patients) and graft loss was 3.5% (2 patients). Due to the good results, this technique became the standard surgery for transplantation of the pancreas in our center. The technique proved to be safe and successful. Due to the unique pancreas graft implantation, we called it "transverse pancreas surgery."

The authors present a case of a 27-year-old multiparous woman, with multiple thrombophilia, whose pregnancy was complicated with deep venous thrombosis requiring placement of a vena cava filter. At 15th week of gestation, following an acute deep venous thrombosis of the right inferior limb, anticoagulant therapy with low-molecular-weight heparin (LMWH) was instituted without improvement in her clinical status. Subsequently, at 18 weeks of pregnancy, LMWH was switched to warfarin. At 30th week of gestation, the maintenance of high thrombotic risk was the premise for placement of an inferior vena cava filter for prophylaxis of pulmonary embolism during childbirth and postpartum. There were no complications and a vaginal delivery was accomplished at 37 weeks of gestation. Venal placement of inferior vena cava filters is an attractive option as prophylaxis for pulmonary embolism during pregnancy.

ABSTRACT Objective: To determine the efficacy of Deep Venous Thrombosis (DVT) prophylaxis protocol in patients undergoing total hip arthroplasty (THA), and to verify differences in the rates of this complication when comparing primary replacement surgeries with revision surgeries. Methods: We conducted a retrospective study of patients operated between 2012 and 2018, with inclusion and non-inclusion criteria determined by the researchers. A protocol was created to compile data including 92 patients, amounting to 110 operated hips, divided by gender, age, laterality, among other criteria. For THA cases, low molecular weight heparin chemoprophylaxis was used, associated with the use of pneumatic and elastic compression, concomitant to deambulation as soon as possible. The detection of DVT was determined by clinical evaluation and imaging exams such as: simple radiographs, ultrasound, arterial and venous color doppler, and laboratory tests. Results: The use of the protocol was very effective in our study. Only one (1.09%) case of deep venous thrombosis was found. Conclusion: The use of thromboprophylaxis for DVT is indispensable, as was clearly demonstrated by these cases. We observed only one (1.09%) case of DVT in our series. Level of Evidence III, Retrospective Study.

ABSTRACT Introduction: Hemodialysis vascular access thrombosis is an acute event that can interrupt the dialytic treatment. A timely management can restore access patency, avoiding the use of central venous catheters and their complications. Objective: To present the experience from a Brazilian Interventional Nephrology Center (INC) in the salvage of arteriovenous fistula (AVF) and grafts for hemodialysis. Methods: A retrospective study was performed to evaluate the primary and secondary patencies of 41 hemodialysis accesses with thrombosis confirmed by ultrasound and submitted to endovascular salvage procedures. We considered clinical success the use of the access for at least 3 subsequent hemodialysis sessions. The procedures were done in an outpatient center by interventional nephrologists. Patients were followed for up to 18 months with Doppler every 3 months. Results: Forty-five salvage procedures were performed in 41 accesses of 40 hemodialysis patients with native AVF or grafts. Of these, 90% were AVF, mostly upper arm, and 10% were grafts. Clinical success rate was 60% (27 procedures). Primary patency at 12 months was 39% and secondary was 52%. Gender of the patient, diabetes, and location of the access did not correlate statistically with outcomes. There were 3 major complications (anastomosis rupture, grade 3 hematoma, and anaphylactic shock). Conclusion: The majority of thrombosed accesses can be successfully treated, maintaining its long-term patency. The need of repeated intervention is frequent.